Chapter 1: In-office teeth whitening

Introduction

Why choosing teeth whitening at a dental office rather at home?

What are the pros and cons?

How do different procedures work and what are the differences?

In this article we are going to address some of these questions and more, by focusing on in-office teeth whitening.

So, without preamble, let’s dive right in.

Dental cleaning: preparing for in-office teeth whitening

What do I need to do before in-office teeth whitening?

Getting your teeth whitened in your dentist’s office can yield quick results.

So, to score a gleaming smile it may be well worth its while to prepare yourself for the procedure.

Here is what you need to do. Before teeth bleaching at a dental office you:

  • Should brush your teeth.
  • Consider using lip balm before to avoid dry or sore lips.
  • Should also get your teeth cleaned.

A couple of comments regarding the last point.

If you are hoping that you can remove plaque and tartar at home … you will soon be disappointed.

They are hard to get rid of.

Unfortunately, you will require professional help, either by a dentist or by a dental hygienist.

Now, removing them is really necessary before teeth whitening.

Dental plaque and gum inflammation

Why?

Because a whitening gel cannot penetrate through calculus and plaque. Their presence will lead to blotchy results.

Besides, when a hygienist polishes your teeth, she will remove some of your surface stains.

Hence, the whitening gel will better penetrate within your enamel.

Finally, dental cleaning may show some cavities or leaking dental fillings.

And these need to be addressed before teeth whitening!

But could dental cleaning be enough to restore your teeth’s original color?

This would be great would it not?

You will avoid the extra cost and time of teeth whitening procedures, whether at home or the dental office.

The answer is negative, unfortunately.

Simple dental cleaning and polishing may be enough to remove your superficial stains (see also What will my final result be like after in-office teeth whitening? .

But for deeper stains that penetrate the enamel and even dentin, you will need to change to a more “robust approach.”

And that is typically where in-office teeth whitening comes in.

If you continue reading, we will unveil its secrets 😉.

How calculus can lead to gingivitis and finally periodontal disease

In-office dental bleaching

How does in-office teeth whitening work?

Dentist performing teeth whitening treatment

Now, not all procedures are created equal. 😉

Yes, there are some variations amongst different procedures.

But do not worry. We describe the main steps below, and we will explain the differences in the next sections.

All in-office teeth whitening procedures follow a somewhat standard routine. A trained dentist will:

  • Take a shade measurement of your teeth before the procedure begins.
    • Shade measurement aims to compare your existing tooth color to a shade with a stylized chart.
    • This provides a benchmark to gauge improvement after teeth whitening.
    • Once this (benchmark) has been determined, the whitening process will take place.
  • Polish your teeth using pumice.
  • Place a cheek retractor to expose all the teeth that are visible when you smile.
  • Cover your eyes, gums, and lips, to protect them from the bleaching gel.
    • A hardening resin or a liquid rubber dam is used and painted over the gums.
    • The tips of the gums between the teeth will also be protected from the bleaching agents.
    • Finally, only your teeth will be exposed. This process may take up to 10 minutes.
  • Apply a special whitening gel to your teeth.
  • Remove the previous layer during each session.
    Patient undergoing in-office teeth whitening. Gums are protected from contact with whitening gel. Cheek retractors are in place
    Patient with cheek retractors during in-office teeth whitening. Gums are protected.
  • Make you rinse your mouth with a lot of water, and polish your teeth with pumice again (if necessary).
  • Assess the degree of teeth whitening to gauge whether the procedure should be repeated or not.
  • Apply more whitening gel if necessary.
  • Remove your cheek retractors so that you can rinse your mouth.
  • Take your final teeth shade.

Temporary dehydration of your teeth may enhance the immediate postoperative result.

According to the ADA:

  • “heat and light application may initially increase whitening due to greater dehydration”;
  • “this reverses with time” and is also referred to as rebound;
  • the final color will be visible 2-6 weeks after the procedure.1

For some whitening procedures, your dentist will expose and activate the gel during each session.

He will use a special high-intensity UV light for this.

Let’s now talk about a topic which may be top of mind for you … number of treatments.

How many visits and in-office teeth whitening procedures do you need?

You will be happy to hear that …

Your dentist will usually not have to set up a regime with multiple visits to get your healthy grin back.

The average is one visit.

Albeit, depending on the results, or your desired outcome, another session may be necessary.

Your dentist may also suggest continuing the treatment with home whitening trays.

So, tray delivery may help complete the whitening process.

Albeit, depending on the individual case, the exact approach could vary.

We previously mentioned the use of light sources.

Let’s investigate a little.

How many light sources can be used during accelerated or LED in-office teeth whitening?

Your best guess? One, two or more sources?

Actually, the correct answer is three.

The following sources of light are the most frequently used:

  • LED,
  • plasma arc,
  • and halogen.

The type of light that best activates hydrogen peroxide is in the blue spectrum.

This is because hydrogen peroxide’s molecules absorb light in these wavelengths.

What about laser light?

Is it ever used?

Scroll down.

Is laser light, used for in-office teeth whitening, effective?

The short answer is that there is not a lot of data about the efficacy of laser bleaching.

Also, the data is difficult to compare because of the differences:

However, some comparative studies with high concentrations of hydrogen peroxide showed improved whitening.

Bear in mind though that:

  • “Most often, comparable results were found irrespective of light exposure.”3
  • “There is no evidence that light activation (power bleaching with high-intensity light) with high concentrated hydrogen peroxide bleaching gels results in more effective bleaching with a longer lasting effect.”4

Let’s leave the world of light sources and get back to some more practical questions.

Is in-office teeth whitening painful or uncomfortable?

Fear not, my young Padawans. 😉

The procedure is neither painful nor uncomfortable.

To the point that most patients usually listen to music, watch a DVD or doze off, during the entire procedure.

Yes, you understood right, most patients are very relaxed.

Light activation of teeth whitening gel during an in-office teeth whitening procedure

What are the advantages and disadvantages of in-office teeth whitening?

If you want fast results, in-office procedures are the way forward.

Unlike home bleaching techniques, results are quick and visible after a one-hour session.

Home whitening techniques instead are slower and are intended to be used over a period of 2-4 weeks.5

However, you will benefit from staying in the comfort of your own home.

Also, they are less expensive.

Zoom® and Opalescence® Boost

Which in-office teeth whitening procedures are most common?

You probably remember that we promised explaining variations amongst different in-office teeth whitening procedures.

Since a promise is a promise!

… Let’s look at the two most popular ones.

These are:

  • Zoom®
  • Opalescence® Boost

What is Opalescence® Boost?

It is an in-office teeth bleaching procedure that:

  • Lasts about an hour, depending on the degree of tooth discoloration.
  • Does not need light to activate the gel.
  • Whitens your teeth with a sticky and viscous gel, which stays in place on your teeth.
  • Can remove common stains brought about by your lifestyle (eating, drinking smoking, …).
  • Can also treat other difficult stains like those resulting from:
    • trauma;
    • prescription medications (tetracycline).

Now, after the procedure, you may experience post-whitening sensitivity.

To alleviate that, your dentist should give you a potassium nitrate gel.

You can use it in a customized tray until the condition subsides.

So, nothing to be too concerned about.

Let’s now learn about the other most popular in-office (teeth whitening) method.

What is Zoom® teeth whitening?

Patient with a light source device irradiating teeth whitening gel, during an in-office procedure

Zoom® is a very popular teeth whitening procedure that:

  • Generally, lasts about 1 hour and is done at the office.
  • Consists of three 15 minutes applications of a whitening gel. These contain hydrogen peroxide (25%). They lighten both enamel and dentin stains.
  • Makes use of an ultraviolet lamp to speed up the whitening process.

So unlike Opalescence® Boost, light is part of the bleaching process.

A small percentage of patients (about 7-8 %) experience sensitivity.

It subsides significantly after 24 hours and should completely disappear within 48 hours.

Are you concerned about sensitivity? Then check Chapter 4: Sensitivity and gums’ irritation after teeth whitening)

To address that, post-treatment care instructions include the application of a fluoride paste-gel to your teeth.

This is done right after the procedure.

Final remarks

Was the discovery of in-office dental procedures interesting?

This chapter should serve as a stepping stone to a better decision making when you want to restore your pearly whites’ natural color.

And to really take good decisions …

Well, you should really have all the necessary information.

For that, check also the remaining chapters:

(and also Teeth Whitening: The Definitive Guide for 2019 in case you have not read it yet).


Bibliography

  1. JADA – A CLINICAL EVALUATION OF CARBAMIDE PEROXIDE AND HYDROGEN PEROXIDE WHITENING AGENTS DURING DAYTIME USE
  2. NCBI – Laser Teeth Bleaching: Evaluation of Eventual Side Effects on Enamel and the Pulp and the Efficiency In Vitro and In Vivo
  3. NCBI – Laser Teeth Bleaching: Evaluation of Eventual Side Effects on Enamel and the Pulp and the Efficiency In Vitro and In Vivo
  4. NCBI – Laser Teeth Bleaching: Evaluation of Eventual Side Effects on Enamel and the Pulp and the Efficiency In Vitro and In Vivo
  5. ADAStatement on the Safety and Effectiveness of Tooth Whitening Products